• Journal of Chest Surgery
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• 제55권6호
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• pp.462-469
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• 2022

Background: Carotid endarterectomy (CEA) is used to treat carotid stenosis, which is associated with cerebral infarction and may result in neurologic deficits such as stroke, transient ischemic attack (TIA), and local nerve injury. To decrease surgery-related complications and improve patient satisfaction with esthetic outcomes, efforts have been made to minimize incision size instead of using a standard longitudinal incision. Methods: We performed a retrospective analysis of 151 cases of CEA, of which 110 used conventional incisions and 41 used high mini-skin incisions (HMIs), from March 2015 to December 2021 at a single institution. Short-term (30-day) postoperative results were evaluated for rates of mortality, stroke, TIA, and cranial/cervical nerve injuries. Risk factors for nerve injury were also assessed. Results: The HMI group showed significantly (p<0.01) shorter operative and clamp times than the conventional group. The HMI group also had significantly shorter incision lengths (5.3±0.9 cm) than the conventional group (11.5±2.8 cm). The rates of stroke, TIA, and death at 30 days were not significantly different between the 2 groups. There was no significant difference in the rate of cranial and cervical nerve injuries, and all injuries were transient. A high lesion level (odds ratio [OR], 9.56; 95% confidence interval [CI], 3.21-28.42; p<0.01) and the clamp time (OR, 1.07; 95% CI, 1.03-1.12; p<0.01) were found to be risk factors for nerve injuries. Conclusion: Use of the HMI in CEA for carotid stenosis was advantageous for its shorter operative time, shorter internal carotid artery clamp time, reduced neurologic complications, and improved esthetics.

• Journal of Chest Surgery
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• 제49권1호
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• pp.22-28
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• 2016

Background: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. Methods: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. Results: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. Conclusion: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.

• 한국정보과학회논문지:소프트웨어및응용
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• 제30권12호
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• pp.1247-1254
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• 2003

현재 경동맥 내막절제술 시행을 위한 경동맥 협착증의 정도 측정에는 디지털감산조영술(DSA), 회전조영술(rotational angiography), 컴퓨터단층조영술(CTA) 및 자기공명조영술(MRA)로부터 얻어진 경동맥의 투영 영상을 이용하여 북미, 유럽 표준 및 총경동맥 방법이 사용되고 있다. 본 논문에서는 기존의 기계적인 측경기를 이용하는 전형적인 경동맥 협착 측정 방법의 단점을 극복하고, 측정자간의 변화율을 최소화하기 위해 자기공명조영술의 단면 영상을 사용하고 컴퓨터화한 새로운 협착증 정도 측정 방법을 개발하였다. 영상 분할에 사용되는 방법중 가장 널리 사용되고 효율적인 명암값 임계치 방법을 사용하여 경동맥 및 동맥의 내강을 분할하였다. 또한, 각 증례의 측정된 총경동맥의 혈관두께를 사용하여 분할된 경동맥으로부터 혈관을 제거 하였고, 혈관이 제거된 경동맥을 혈류 영역과 플라그 영역으로 분할하였다. 각 단면 영상에서의 경동맥 협착증 정도 측정은 (분할된 플라그 영역/혈류영역 및 플라그를 합한 면적) * 100% 식으로 계산된다.

• 한국산학기술학회논문지
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• 제19권2호
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• pp.456-461
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• 2018

목동맥 스텐트 삽입술은 목동맥 내막절제술에 적합하지 않은 환자에게 시행할 수 있는 목동맥 협착증의 대체 치료법으로 알려져 있다. 목동맥 내막절제술, 혈관성형술 또는 스텐트 삽입술 후에 드문 부작용으로 뇌내출혈이 발생할 수 있고, 이러한 출혈이 발생하는 원인은 대부분의 경우 재관류 손상과 관련이 있는 것으로 추정하고 있다. 이전의 연구에서는 내막절제술과 비교하여 목동맥 스텐트 삽입술 후 뇌내출혈의 빈도가 더 높다고 보고한 바 있다. 본 연구에서는 뇌경색으로 내원한 80세 남자환자를 대상으로 증례보고를 통해 동일 분야 연구에 활용하고자 자료 분석을 하였다. 80세 남자가 갑자기 발생한 오른 팔의 근력저하를 주소로 방문하였다. 왼쪽 속목동맥의 90% 협착이 발견되어 목동맥 스텐트 삽입술을 시행하였고, 시술 후 실시한 뇌 CT에서 시상을 포함하는 후대뇌동맥 영역의 뇌출혈이 뇌실내출혈까지 진행되어 있음을 관찰하였다. 이러한 출혈은 스텐트 삽입술이 시행된 동맥에서 공급될 가능성이 낮은 혈관 영역에서 발생했기 때문에, 이 경우에 내막절제술 시행 후 과다혈류에 의한 출혈과 다른 양상을 확인하였다.

• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.350-354
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• 2009

Objective : The purpose of this study was to analyze the clinical outcome of 75 consecutive patients with cervical carotid artery stenosis and who were treated by carotid artery stenting (CAS) only. Methods : From February 2003 to June 2008, there were 78 stents placed in 75 symptomatic patients (mean age : 67.3 years); 69 patients had carotid stenosis ${\geq}70%$, and 6 patients had asymptomatic stenosis ${\geq}80%$. No carotid endarterectomy (CEA) was performed during the same period. The patients were clinically followed-up for a mean of 20.1 months. Results : The procedures were technically successful in all cases. Three (3.8%) patients had procedure-related complications. During the 30-day postprocedural period, there were no restenosis or major stroke. Minor stroke was noticed in 3 (3.8%) patients and 1 (1.3%) of the 75 patients suddenly expired 2 days after discharge. There were no new neurological symptoms that developed during the clinical follow-up period. The results of our series were not inferior to those the previously published in CAS studies, and in fact they were better. Conclusion : Our results suggest that CAS may be safe and useful for the treatment of cervical carotid artery stenosis when it is used as the first line treatment in those institutions that lack enough experience with CEA.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.284-294
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• 2001

Objective : Stroke is leading cause of death and more importantly it is cause of serious disability. The effective treatment of acute ischemic stroke still remains a challenge to modern medicine. Recent clinical trials have shown that carotid endareterctomy(CEA) provide overwhelming benefits compared with medical therapy in preventing subsequent stroke for symptomatic carotid stenosis. For the asymptomatic ones, the data are less compelling, but highly suggestive that CEA do have benefits in properly selected patients. Materials and Methods : To investigate the clinical manifestations of carotid stenosis and results of CEAs, authors analyzed retrospectively 19 CEAs in 16 patients from June 1986 to June 1999. Age of patients ranged from 55 to 76 years(median, 66) and male to female ratio was 14 to 2. The duration of follow-up was 1 to 144 months (median, 26). All of CEAs were done on the side of stenosis more than 80% and bilateral CEAs were done in three. Six CEAs were performed in asymptomatic patients. Results : Seventeen of 19 CEAs showed excellent results and complication rate was low although ipsilateral ischemic stroke occurred in two. Conclusion : CEA may be a valuable surgical treatment for ischemic stroke caused by carotid stenosis and also for prevention of stroke of asymptomatic patients with carotid stenosis.

• Journal of Chest Surgery
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• 제30권6호
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• pp.625-630
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• 1997

56세 남자 환자가 신경과에 내원하였는데, 그는 최근에 심해지는 우측 세번째에서 다섯번째 수지의 반복 적인 저린 통증과 파악력의 약화를 주소로 하였다. 이와 함께 보행시 하지 동통을 호소하였다. 경동맥 조영술상 우내경동맥이 완전히 막혀 있었고 좌우총경동맥과 외경동맥, 좌내 경동맥은 심각한 협착이 있었다. 함께 시행한 대동맥 조영술상 신동맥이하는 완전한 폐색을 보였고 양측 대퇴 동맥은 지연 조영 을 보였다. 두개의 동맥 병변에 대해 단계별로 수술 계획을 세웠다. 양측 경동맥 병변은 경동맥 내막절제술을 시행 하였다. 이 때 좌측은·경동맥 션트를 사용하였다. 복부대동맥 병변은 2주후에 시행되었으며 복강동맥하방의 대동맥을 결찰하고 허혈시 신장을 보존하기위 해 신보존액을 주입하였다. 역 Y 회로 이식술과 신보존을 시행하여 린분간의 허혈동안에도 성공적으로 시술되었으며 별다른 문제없이 술 후 보름만에 퇴원하였다.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.327-329
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• 2007

A 44-year-old woman presented with recurrent, transient episodes of left-side hemiparesis. She had received a radiation dose of 6120 cGy to her cervical region for parotid gland carcinoma 13 years previously. Cerebral angiography revealed a long, irregular tight stenosis involving the right extracranial internal carotid artery [ICA] and common carotid artery [CCA], measuring approximately 90% at the most severe narrowing according to North American Symptomatic Carotid Endarterectomy Trial criteria. Endovascular stent placement resulted in restoration of the carotid lumen to about 80% of its original diameter. She showed no further ischemic events during the follow-up period of 48 months. Our clinical and angiographic findings suggest that carotid stenting is considered a safe and effective treatment option in patients with radiation-induced carotid stenosis.

• Journal of Korean Neurosurgical Society
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• 제52권6호
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• pp.551-554
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• 2012

Alternative to carotid endarterectomy, carotid artery stenting (CAS) can be performed for symptomatic severe stenosis of internal carotid artery, especially for high-risk patients. Among several complications after CAS, subacute in-stent thrombosis is rare but important, because patient's condition can deteriorate rapidly. Subacute in-stent thrombosis with carotid artery occlusion can be managed by superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. We report two cases of STA-MCA anastomosis for internal carotid artery occlusion by subacute in-stent thrombosis after CAS.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.70-75
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• 1999

Trancranial Doppler(TCD) monitoring is a new application of ultrasonography which allows the nonivasive detection of blood flow velocity in the horizontal (M1) segment of the middle cerebral artery (MCA) and detects microembolic phenomena in the cerebral circulation. Recent studies emphasized the potential of using this technique in vascular surgery (carotid endarterectomy, cardiopulmonary bypass), interventional and intensive care setting. Although the disparity between CBF and blood flow velocity and number of microemboli could be used to prevent cerebral ischemic and embolism based on clinical studies. A reduction of more than 60% of MCA can reflex hemodynamic ischemic state and acoustic feedback of high intensity transient signals(HITS) from the TCD monitoring unit has a direct influence on surgical technique. TCD monitoring can immediately provide information about thromboembolism and hemodynamic changes, which may be a useful tool in the study and prevention of stroke.